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Transcript
BONE DISEASE BONE REACTIONS •Heal/reacts •Becomes infarcted •Can be infected •Atrophies •Sensitive to body environment •Neoplastic transformation DISEASE CATEGORY • Traumatic • Circulatory • Infection • Metabolic • Congenital • Neoplastic BONE REMODELING 15% of skeleton/year FRACTURE HEALING • Hematoma • Granulation Tissue • Cartilage • Remodeling • Osteoid FRACTURE COMPLICATIONS •Necrosis •Malunion •Non-Union Non-union STRESS FRACTURE PATHOLOGIC FRACTURE Heterotopic ossification HETEROTOPIC OSSIFICATION •Single Episode of trauma •Repetitive Minor trauma •No history of injury What is the diagnosis? OSTEONECROSIS • Bone Infarction (Segment of Dead Bone) OSTEONECROSIS •Trauma •Systematic Process OSTEONECROSIS • Traumatic injury to blood vessels -- Fractures -- Dislocations PATHOGENESIS •Final common pathway •Intravascular coagulation OSTEONECROSIS •Intravascular coagulation -- Hypercoagulable blood -- Fat Swelling -- Lipemic serum OSTEONECROSIS •Alcoholism •Steroid Therapy •Sickle Cell Disease •Caisson Disease •Gaucher’s Disease OSTEONECROSIS •Steroid therapy -- Transplantation – 15% -- Systematic Lupus – 30% OSTEONECROSIS •Spontaneous -- Hip -- Knee -- Shoulder OSTEONECROSIS •Femoral Head -- 15,000 cases/year U.S. -- Ages 20 – 40 -- Usually Men CAISSON DISEASE PAGET’S DISEASE Focal or multifocal increased and chaotic bone remodeling PRIMARY OSTEOCLAST DYSFUNCTION PAGET’S DISTRIBUTUION •A PORTION OF ONE BONE -- Entire skeleton •Axial Skeleton -- spine -- pelvis -- skull PAGET’S DISEASE •Architectural distortion of bone -- pain -- deformity -- fracture -- other COURSE TRABECULAE BONES ARE BRITTLE BANANA FRACTURE Paget’s Disease Chaotic,exagerated bone remodelling PAGET’S DISEASE •Other Complications -- Anemia -- Cranial Nerve Palsy -- Heart Failure -- Sarcoma PAGET’S DISEASE – INFECTIOUS? 1. Viral particles consistent 2. Geographic predilection 3. Familial clustering AGE 10 FEVER, PAIN WBC, SED RATE WHAT IS YOUR DIAGNOSIS? •Bone Infection •Osteomyelitis OSTEOMYELITIS Primary: Hematogenous Secondary: Direct implantation of organisms PRIMARY OSTEOMYELITIS •Children •Staph aureous •Pain, fever, leucocytosis OSTEOMYELITIS • Acute osteomyelitis -- 5% to chronic • Chronic osteomyelitis -- long standing (many years) --bony reaction to organisms PRIMARY OSTEOMYELITIS - ADULT •Spine •Follows GU tract •Manipulation SEQUESTRUM PATHOGRAPHY METABOLIC BONE DISEASE • Disorders of the chemical milieu of the body which leads to decreased bone mass BONE TUMORS WHAT IS THE DIAGNOSIS?
